Special Feature: Retail Clinics Play Growing Role in Health Care Marketplace
Visits to retail clinics quadrupled from 2007 to 2009 - but what do we know about this rapidly emerging medical setting?
Retail clinics are medical clinics located in pharmacies, grocery stores, and “big box” stores, such as Target. They provide care for simple acute conditions—such as bronchitis and vaccinations—typically delivered by a nurse practitioner. Increasingly, retail clinics provide individuals with preventive care, as well.
The popularity of retail clinics has grown substantially over the last decade. The first clinics began opening in 2000, and by 2010 they numbered close to 1,200. While visits to retail clinics comprise a small percentage of overall outpatient visits, they quadrupled from 2007 to 2009. Americans made almost six million visits to retail clinics in 2009 alone.
With the role of retail clinics expanding and U.S. health care entering a dynamic period of change, it is important to consider what we know about this emerging health care setting.
Why do people use retail clinics?
Retail clinics emphasize convenience, with extended weekend and evening hours, no appointments, and short wait times. More than 44 percent of retail clinic visits take place when physician offices are typically closed. Price transparency and low costs may also be particularly attractive for people without insurance.
The rapid growth of retail clinics since 2000 clearly suggests that they are meeting a patient need.
Who uses retail clinics?Click to Enlarge
According to a RAND study that examined more than 1.3 million retail clinic visits, young adults (ages 18-44) account for 43 percent of retail clinic patients, compared to only 23 percent of patients who visit primary care physicians. Patients are also less likely to have a personal doctor and less likely to pay for care with health insurance.
However, a more recent study indicates a shift in the age distribution among retail clinic patients, with visits by seniors increasing from 7.5 percent in 2000-06 to 14.7 percent in 2007-09.
Where are retail clinics located?
The majority of retail clinics are located in the South (43 percent) and the Midwest (31 percent), with 44 percent of all clinics located in five states: Florida, California, Texas, Minnesota, and Illinois. They are more likely to be located in metropolitan areas that have lower poverty rates and higher median incomes.
While an estimated 36 percent of the country's urban population lives within a 10-minute drive of a retail clinic, clinics are less likely to be located in medically underserved neighborhoods than in other areas. So while retail clinics are widespread and easily accessible to many Americans, evidence does not support the idea that they improve health care access for underserved populations.
What services do retail clinics provide?
Approximately 90 percent of retail clinic visits were for ten simple acute conditions and preventive care:
Who owns and operates retail clinics?
As of 2010, three organizations—CVS, Walgreens, and Target—operated 73 percent of retail clinics. More than half of the 42 organizations that operate such clinics were hospital chains or physician groups (e.g., the Mayo Clinic), but these organizations operated only 11 percent of the clinics. Some retail clinics have begun partnering with integrated delivery systems, like Allina Health and the Cleveland Clinic.
Are there any concerns about retail clinics?
Provider groups, such as the American Medical Association, have raised concerns about quality of care among retail clinics, including the potential overprescribing of antibiotics, lost opportunities for preventive care, and the disruption of existing patient-physician relationships. Because they're so convenient, health plans are concerned that patients will visit retail clinics instead of staying home. Such new care could drive up health care spending.
Are these concerns valid?Click to Enlarge
A growing body of evidence suggests that they are not.
Overall, costs of care for episodes initiated at retail clinics are substantially lower than similar episodes initiated at physician offices, urgent care centers, and emergency departments. Despite the lower cost, however, retail clinics' quality-of-care scores have also been comparable to more conventional care settings.
Concerns that retail clinics could overprescribe antibiotics notwithstanding, the share of patients prescribed antibiotics at retail clinics was similar to other care settings. Finally, because the majority of retail care patients reports no primary care physician, clinics may not disrupt patient-physician relationships for most patients. For the minority of patients who report a primary care physician, it is possible that some aspects of the relationship could be disrupted. However, it is reassuring that the proportion of patients who receive preventive care does not vary compared to other settings.
What's next for retail clinics?
Many factors could influence the future of retail clinics in the U.S. First, the growing body of evidence casting doubt on quality-of-care concerns could lead to greater acceptance and use of retail clinics.
Full implementation of the Affordable Care Act (ACA) could also lead to continued retail clinic growth. With more people insured and an increased demand for primary care under the ACA, access to primary care physicians could decrease. This may lead to increased demand for retail clinics. Similarly, if wait times for physician appointments increase—as has been the case in Massachusetts following its health reform—this could also increase retail clinic demand.
On the other hand, online care—or “eVisits”—offered by some health care systems and private companies could emerge to compete with retail clinic visits, thus slowing the their growth.